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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015600032
Report Date: 11/08/2023
Date Signed: 11/08/2023 12:04:12 PM


Document Has Been Signed on 11/08/2023 12:04 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:P & R RESIDENTIAL CARE (FOR ELDERLY)FACILITY NUMBER:
015600032
ADMINISTRATOR:SAN MIGUEL, PRECILLAFACILITY TYPE:
740
ADDRESS:32262 CREST LANETELEPHONE:
(510) 489-8082
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:6CENSUS: 0DATE:
11/08/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Precilla San MiguelTIME COMPLETED:
12:15 PM
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On this day, Licensing Program Analyst (LPA) Luisa Fontanilla arrived to conduct case management closure visit and met with Licensee/Administrator Precilla San Miguel. Licensee arrived at the facility at 11:30 am.

LPA observed workers fixing the roof. LPA inspected the facility inside and out including but not limited to bedrooms, bathrooms, kitchen, dining, garage and backyard. There were no residents observed. Construction materials were observed in the garage and backyard.

Administrator states the last resident moved out on October 5, 2023.

LPA received closure notification from facility on October 2, 2023 stating that facility is no longer interested in operating effective November 1, 2023. Original facility license was surrendered to LPA during the visit.


SUPERVISOR'S NAME: Yvonne Flores-LariosTELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Luisa FontanillaTELEPHONE: (510) 286-7147
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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